USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1951 > Part 85
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death certificate contains a recital, as required by section ten of chapter forty-six. that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate. shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner of cause of the death, which the clerk or registrar may require. -- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupatibn, or suddenly when not disabled by recognizable disease, or when any person is found dead. - General Laws, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deathsonly as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
R-302 1
PLACE OF DEATH
Middlesex (County) Arlington
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF
CERTIFICATE OF DEATH
Arlington
(City or town making return)
Registered No.
464 237
(City or Town) Abbott's Convalescent Home No.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
15 Park Circle George .... A. Myers
(If deceased is a married, widowed or divorced woman, give also maiden name.)
359 Shirley Street
St.
Winthrop
Mass.
(a) Residence. No. (Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death.
.years.
months.
23
days. In place of residenceLO
.years
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
October
30
1951
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
4 I HEREBY CERTIFY,
Oct. 20
51
19
to
Oct. 30
19 ..
51
I last saw
h
im
alive on
Oct.
30
.... 19 57 death is said to
have occurred on the date stated above, at.
4:30P
.m.
INTERVAL BE-
(Husband's name in full)
DISEASE OR CONDITION DIRECTLY LEADING
TO DEATH
(a).
Carcinoma of
the lung
ANTE Due To CEDENT (b) CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Carcinoma of lung
Date of operation Sept .... 1951was autopsy performed?
No
What test confirmed diagnosis ?.
Biopsy ..
5 Was disease or injury in any way related to occupation of deceased ?. NO.
If so, specify,
(Signed)
Tilliam A. Dawa, Jr.
M.D.
(Address) Arlington Mass, Date 10-30- 1951
Roxbury Mutual Cem -Montvale 6
Place of Burial or Cremation (City or Town)
DATE OF BURIAL.
November
1
1951
7 NAME OF
FUNERAL DIRECTORBenjamin F. Solomon
ADDRESS
420 Harvard St., Brookline
Received and filed 19
NOV & 1951
(Registrar of City or Town where deceased resided)
11 IF STILLBORN, enter that fact here.
12
69
AGE
Years
Months
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation:
Cigar Maker
(Kind of work done during most of working life)
14 Industry
or Business:
Cigar
15 Social Security No.
032-03-3906
16 BIRTHPLACE (City).
(State or country)
England
17 NAME OF
FATHER
Wolf. Myers
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
England
19 MAIDEN NAME
OF MOTHER
Esther Durand
20 BIRTHPLACE OF
MOTHER (City)
-
(State or country)
England
21 William Myers
Informant
(Address)
36 Forrest Sto, Winthrop
A TRUE COPY
ATTEST:
Registrar of City of Town where death occurred)
DATE FILED
October
31
19
51
10a If married, widowed, or divorced
HUSBAND of.
Sadie Moscow
(Give maiden name of wife in full)
(or) WIFE of
TWEEN ONSET AND DEATH 1 yr
50m-(e)-10-48-24658
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time
(Was deceased a
U. S. War Veteran,
No
{ if so specify WAR)
(write the word)
That I attended deceased from
١٠
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Ser 12, G. L.)
25M (E )-6.50.902253
PLACE OF DEATH
Essex (County)
Danvers
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danw.r.s
(City or town making return)
238
f(If death occurred in a hospital or institution, No. Danvers ... State ..... Hospital, ... Hathorne
2 FULL NAME. Charles Rogers
(If deceased is a married, widowed or divorced woman, give also maiden name.)
63 Fremont
St.
Winthrop
(a) Residence. No. (Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years ..
1months 5
days. In place of residence.
... years.
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
October
20,
19.5.1
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Sept .15, 19 51
to
Oct. 20
19
51
I last saw h
im alive on
Oct. 20
19.51
death is said to
10a If married, widowed, or divorced,
HUSBAND of
Unknown
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
Years.
Months.
Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation:
Attorney
( Retired )
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No ..
Unknown
16 BIRTHPLACE (City)
(State or country)
Mass.
Chelsea
17 NAME OF
FATHER
Charles Richard Roger
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Mass
19 MAIDEN NAME
OF MOTHER
Grace Alice Wilkins
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass.
Boston
21 Mary E. Sheehan
Informant.
(Address)
Hathorne, Mass.
A TRUE COPY
ATTEST:
(Registrar of City or Town where death osgurred)
October
30,
51
(Registrar of City or Town where deceased resided)
8 SEX
Male
9 COLOR OR RACE
White
MARRIED
WIDOWED
or DIVORCED id owed
have occurred on the date stated above, at.
9:30 a.m.
INTERVAL BE-
DISEASE OR CONDITION DIRECTLY LEADIN TO DEATH (a)
Generalized Arterio-
sclerosis
years
ANTE CEDENT (b) CAUSES
Due To
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation
Was autopsy performed ?.
No
What test confirmed diagnosis?
Lab. & Clinical
5 Was disease or injury in any way related to occupation of deceased? if so, specifyAndrew Nichols 3rd. (Signed) Danvers, Mass.
(Address)
WinthropCemetery 6
Place of Burial or Cremation (City or Town)
DATE OF BURIAL
October
23. ...... 1951
7 NAME OF
FUNERAL DIRECTOR
Howard S .Reynolds
Winthrop, Mass.
ADDRESS
Received and filed NOV 1 5 1951 19
DATE FILED
19
R-302 1
Registered No.
St. [ give its NAME instead of street and number) - (Was deceased a U. S. War Veteran, if so specify WAR)
10 SINGLE
(write the word)
(Give maiden name of wife in full)
TWEEN ONSET
AND DEATH
73
Boston
PARENTS
Date
10/30/M.59-
Winthrop
R-302 1
PLACE OF DEATH
...
Suffolk (County)
Revere
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Revere
(City or town making return)
Registered No.
239
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME.
Ester A. Madison (Hull)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 130 Grovers Avenue
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
3
a.s.
years.
months.
days. In place of residence
years
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
October
21
1951
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I_ attended deceased
from
Jan, 10
49
October 21
51
19
to
19
I last saw h
er.alive on
October 211,51
death is said to
3:35 A .m.
have occurred on the date stated above, at.
INTERVAL BE-
DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a) Coronary-occlusion acute
TWEEN ONSET ANO DEATH 1 day
11 IF STILLBORN. enter that fact here.
80
12
AGE
Years
Months.
Days
If under 24 hours
.Hours .......
Minutes
ANTE
Due To
Arteriosclerotic
CEDENT (b)
CAUSES feart Dis.
Due To
General arterio-
(c)
sclerosis
3 years
OTHER
SIGNIFICANT
CONDITIONS
None
Major findings:
Of operations.
None
Date of operation.
Was autopsy performed? No
What test confirmed diagnosis ?.
None
No
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
Myron N. King
MOP
(Address)
Deep River 6 Place of Burial or Cremation October 23
DATE OF BURIAL.
Maurice/Kirby
ADDRESS
Received and filed NOV 14 1951
PARENTS
18 BIRTHPLACE OFDeep River FATHER (City) (State or country) Conn.
19 MAIDEN NAME OF MOTHER Unknown
20 BIRTHPLACE OFDeep River
MOTHER (City)
(State or country)
Conn.
21 Rufus Madison
Informant (Address) Winthrop Arms Hotel
A TRUE COPY.
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
October 30,
.19.51
(Registrar of City or Town where deceased resided)
8 SEX
Female
9 COLOR OR RACE
White-
10 SINGLE
(write the word)
Married
MARRIED
WIDOWED
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
Miles Madison
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
Housewife
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
16 BIRTHPLACE (City).NewYork (State or country)
17 NAME OF
FATHER
Therba Hull
Conn.
(City or Town)
51
19
7 NAME OF
FUNERAL DIRECTOR
Winthrop
St.
10/21
195
Date
3 years
50m-(e)-10-48-24658
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time
(Usual place of abode)
36
Winthrop
(Was deceased a
U. S. War Veteran,
if so specify WAR)
No.
Resthaven
R-302 1
PLACE OF DEATH
SUFFOLK BOSTON
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
9348
Registered No.
210
Mags. General Hospital No.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
Elizabeth Kinnear
(If deceased is a married, widowed or divorced woman, give also maiden name.)
107 Ba doin St
St.
Winthrop Mass.
(a) Residence. No. (Usual place of abode)
25
(If nonresident, give city or town and State)
Length of stay: In place of death
........
.years.
.. months.
10
.days. In place of residence
years.
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Oct.22/51
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY.
Oct. 11 19 51
to
That
I attended deceased
from
Oct. 22
51
19
I last saw }
eralive on
19.
death is said to
12;47P
.m.
INTERVAL BE-
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
Samuel L Kinnear
(or) WIFE of.
(Husband's name in full)
DISEASE OR CONDITION DIRECTLY LEADING
TO DEATH (a)
Nephrosclerosis
3 Yr
Plus
72
12
AGE
Years
0
27
Months
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation:
At Home
18 Yr
Plus
(Kind of work done during most of working life)
14 Industry or Business:
S15 Social Security No ..
None
16 BIRTHPLACE (City)
(State or country)
England.
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
None
Date of operation
.Was autopsy performed?
Yes
What test confirmed diagnosis?
autopsy
5 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed)
CL Clay
M. D
(Address)
Mass General Hoopt
10-225 51
WinthropCem-Winthrop Mass
6
Place of Burial or Cremation
Oct. 25/51
19
21
Informant.
(Address)
S Kinnear
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
Received and filed. 19
NOV 1 3 1951
(Registrar of City of Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City).
(State or country)
England
19 MAIDEN NAME
OF MOTHER
Martha Rogers
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
(City or Town)
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
A B Marsh
ADDRESS Winthrop Mass.
8 SEX
F
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
have occurred on the date stated above. at
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
ANTE
CEDENT (b)
Due To
Diabetes mellitus
Due To
Atrophy of the pancreas
(c)
18 Y P189
Oct. 22
51
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46, Ser 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible CAUSES 25M (E)-6.50.902253
2 FULL NAME
(Was deceased a
U. S. War Veteran,
if so specify WAR)
DATE FILED Oct. 25/51
19
17 NAME OF
FATHER
Samuel Cook
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Ser 12, G. L.)
25M (E )-6.50.902253
PLACE OF DEATHE
DECLINED JURISDICTION SUFFOLK BOSTON
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
9.3.8.8.
241
¡(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
2 FULL NAME. Samuel ... Simons
(If deceased is a married, widowed or divorced woman, give also maiden name.)
12 Nevada St
St
Winthrop Mass
(If nonresident, give city or town and State)
Length of stay: In place of death ..... ... years ... .months. .days. In place of residence .L.Q. .years months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
October 24, 1951
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
4 I HEREBY CERTIFY,
That I attended deceased from
Oct.24
19
.5.1,
to
Oct 24
19 ... 5.1
I last saw }
alive on
19
death is said to
have occurred on the date stated above, at 12:45 pm.
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE
7.1.Years
Months.
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation:
Fruit dealer
(Kind of work done during most of working life)
14 Industry
or Business:
Retired
15 Social Security No.
16 BIRTHPLACE (City).
(State or country)
Russia
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations ..
Date of operation
Was autopsy performed ?..
....... n.o.
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? If so, specify ..
(Signed)
I H Park
(Address) Brookline Mass
Date Oct 24
19.51
6 Everett Beth Israel Cem
Place of Burial or Cremation
Everett Mass
(City or Town)
DATE OF BURIAL
Oct ... 25
1952
21
Informant
(Address)
Wife
7 NAME OF
FUNERAL DIRECTOR
B Birnbach
ADDRESS Boston Mass
Received and filed.
NOV 1 3 1951
19
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Sylvia
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
A TRUE COPY
ATTEST:
happen 21 IMAL
C
(Registrar of City or Town where death occurred)
DATE FILED
Oct ... 2.9.
19.
51
4
ANTE
Due To
CEDENT (b)
CAUSES
Arteriosclerotic
heart disease
Due To
Generalized.arterio
(c)
sclerosis
10a If married, widowed, or divorced
HUSBAND of.
Mary Smokler
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Acute ..... coronary
thrombosis
abt
10 mins
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. (Usual place of abode)
No.
Anne Starr Nursing Home
R-302 1
17 NAME OF FATHER Aaron Simons
+
PLACE OF DEATH
Suffolk (County)
Bos ton
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
Boston
(City or town making return) 9652
Registered No.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
Roderick Murray
(If deceased is a married, widowed or divorced woman, give also maiden name.)
31 Revere
Winthrop Mass.
St.
(a) Residence. No. (Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death. .. years months. 1
days. In place of residence ... ].Q ... years.
.. months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M
9 COLOR OR RACE
10 SINGLE
write the word)
MARRIED
WIDOWED
or DIVORCED
Married
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
Oct. 31
19
51
to.
Nov. 1
51
19
death is said to
have occurred on the date stated above, at
8;OLA
m.
INTERVAL BE-
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
Years
44
3
22
Months
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
Fisherman
(Kind of work done during most of working life)
14 Industry
or Business:
Fish
15 Social Security No ..
022-18-4214
16 BIRTHPLACE (City)
(State or country)
Newfoundland
17 NAME OF
FATHER
John W Murray
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Newfoundland N.S.
Date of operation.
None
Was autopsy performed?
No
What test confirmed diagnosis?
clinical
5 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed)
L Lezer
Mass. General Hospital 11-1
(Address)
Winthrop Cem-Winthrop Lass,
6 Place of Burial or Cremati Nov.5/51 (City or Town)
DATE OF BURIAL 19
7 NAME OF
FUNERAL DIRECTOR
E P Caggiano
ADDRESS Winthrop Mass.
Received and filed. 19
NOV 1 3 1951
(Registrar of City or Town where deceased resided)
PARENTS
19 MAIDEN NAME
OF MOTHER
Annastasia Tucker
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Newfoundland N.S.
Mrs Mary Murray
21
Informant
(Address)
A TRUE COPY
Charge of InaCA
(Registrar of City or Town where death occurred)
DATE FILED
Nov. 5/51
........ 19
10a If married, widowed, or divorced
Mary J Whiffen
HUSBAND of
(Give maiden name of wife in full)
DISEASE OR CONDITION
DIRECTLY LEADING
Myocardial infarction
TWEEN ONSET AND DEATH 15 Hr
TO DEATH (a)
Due To
Arterio sclerotic
disease
Due To (c)
OTHER
SIGNIFICANT
Obstructive vascular
disease .... legs
3} Yrs
3 DATE OF
DEATH
ANTE
CEDENT (b)
CAUSES
Major findings:
Of operations
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time
after the close of the month in which the death occurred. (See Chap. 46, Ser 12, G. L.)
of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible
CONDITIONS
25M (E)-6.50.902253
R-302 1
CERTIFICATE OF DEATH
Mass. General Hospital
No.
Nov. 1/51
That
I attended deceased from
Nov. 1
19
51
I last saw h ... im ... alive on
heart
6 Mos
(or) WIFE of
(Was deceased a
U. S. War Veteran,
( if so specify WAR)
R-301A 1
PLACE OF DEATH
Suffolk
(County) Winthrop
(City or Town) 1 Sea Foam,
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD VIETE CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
243
are
f(If, death occurred in a hospital or institution, St. { give its NAME instead of street and number)
Morris Janeller
(If deceased is a married, widowed or divorced woman, give also maiden name.)
25 Granates
(a) Residence. No. (Usual place of abode)
Length of stay: In place of death years.
/ ... months.
days. In place of residence
40 years
.months. .days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
November
(Month)
(Day)
1951 (Year)
4 I HEREBY CERTIFY,
19
... to 19 ....
I last saw h ............. alive on
19 .---- , death is said to
have occurred on the date stated above, at. 9 A. m.
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Natural causes
ANTE CEDENT (b) CAUSES
Due To
arteno-sclerotic
Heart Disease
Due To
(c)
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations.
Date of operation
Was autopsy performed? no
What test confirmed diagnosis?
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12 AGE . Years
.. Months ... .Days
If under 24 hours .Hours Minutes
13 Usual Occupation:
Junk Dealer
14 Industry or Business!
(Kind of work done during most of working life) For Herical
15 Social Security No ...
16 BIRTHPLACE (City) (State or country)
17 NAME OF FATHER Mah Suneller
18 BIRTHPLACE OF FATHER (City) (State or country)
19 MAIDEN NAME OF MOTHER Jaky Learell
20 BIRTHPLACE OF MOTHER (City) (State or country)
La
Laveller
21 Informant SS 25 Brooks St. E Busco
7 NAME OF FUNERAL DIRECTOR Benjamin Simback
ADDR 10 Washington St Manchester 19
Received and filed ..
NOV 6 1951
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR ÓR RACE What
10 SINGLE MARRIED WIDOWED or DIVORCED Feed
(write the word)
If n HUSBAND of ...
d, or divorced lickson
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
63
PARENTS
5 Was disease or injury in my way related to ochpation of deceased? no
it Canthin C. Man
(Signed))
ess Minthaoch Boand Healthy
M. D.
o levere Com.
Place of Bunal or Cremation
cereal (City or Town)
50M (B)-1.51 903586
JCTIONS OR CERTIFICATE iving F DEATH t enter han one or each ) and (c)
Des not mean dying, such re, asthenia, s the disease, tions which ·
conditions. g rise to the (a) stating ing cause
ns contrib- eath but not disease or using death.
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